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Rennie BJ, Bishop SL, Leventhal BL, Zheng S, Geib E, Kim YS, Burnette C, Salzman E, Nozadi SS, Kim H, Ence W, Park M, Ghods S, Welch M, MacKenzie D, Lewis JL. Neurodevelopmental profiles of 4-year-olds in the Navajo Birth Cohort Study. JAACAP Open 2023; 1:184-195. [PMID: 38239266 PMCID: PMC10795771 DOI: 10.1016/j.jaacop.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Objective Native American children disproportionally face many risk factors for poor developmental outcomes; these factors include poverty, environmental toxicant exposure, and limited medical, and intervention services. To understand these risks, comprehensive documentation of developmental and behavioral phenotypes are needed. In the current descriptive study, we assessed the neurodevelopment of young Diné (Navajo) children using standardized assessment instruments in combination with expert clinician judgment. Methods As part of an ongoing, population-based, prospective birth cohort study, we conducted comprehensive neurodevelopmental assessments of 138, 3-5-year-old, Diné children residing on or near the Navajo Nation. We report results from standardized parent reports, psychiatric examinations, and direct assessments of children's language, cognitive, adaptive, and social-emotional development, as well as best estimate clinical diagnoses. Results Forty-nine percent of our sample met DSM-5 criteria for a neurodevelopmental disorder (NDD) diagnosis. Language and speech sound disorders were most common, although autism spectrum disorder (ASD) was also elevated compared to the general population. Though language performance was depressed amongst all groups of children with, and without, NDDs, those meeting criteria for certain NDDs performed significantly lower on all language measures, when compared to those without. Social-emotional, behavioral, and nonverbal cognitive ability were in the average range overall. Conclusions Diné children in our study were found to have a high percentage of clinically significant developmental delays. Overall, children presented with a pervasive pattern of depressed language performance across measures, irrespective of diagnosis (or no diagnosis), while other domains of functioning were similar to normative samples. Findings support the need to identify appropriate intervention and educational efforts for affected youth, while also exploring the causes of the specific developmental delays. However, longitudinal studies are necessary to establish best practices for identifying delays and delineating resilience factors to optimize development of Diné children.
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Affiliation(s)
| | - Somer L Bishop
- University of California San Francisco Weill Institute for Neurosciences
| | - Bennett L Leventhal
- Community Environmental Health Program, Health Sciences Center, College of Pharmacy, University of New Mexico
- The University of Chicago
| | - Shuting Zheng
- University of California San Francisco Weill Institute for Neurosciences
| | - Ellen Geib
- Nationwide Children's Hospital, Child Development Center
| | - Young Shin Kim
- University of California San Francisco Weill Institute for Neurosciences
| | | | - Emma Salzman
- University of California San Francisco Weill Institute for Neurosciences
| | - Sara S Nozadi
- Community Environmental Health Program, Health Sciences Center, College of Pharmacy, University of New Mexico
| | - Hosanna Kim
- University of California San Francisco Weill Institute for Neurosciences
- University of California Davis Health
| | - Whitney Ence
- University of California San Francisco Weill Institute for Neurosciences
| | - Mina Park
- University of California San Francisco Weill Institute for Neurosciences
| | - Sheila Ghods
- University of California San Francisco Weill Institute for Neurosciences
| | - Maria Welch
- Community Environmental Health Program, Health Sciences Center, College of Pharmacy, University of New Mexico
| | - Debra MacKenzie
- Community Environmental Health Program, Health Sciences Center, College of Pharmacy, University of New Mexico
| | - Johnnye L Lewis
- Community Environmental Health Program, Health Sciences Center, College of Pharmacy, University of New Mexico
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Wispelwey B, Tanous O, Asi Y, Hammoudeh W, Mills D. Because its power remains naturalized: introducing the settler colonial determinants of health. Front Public Health 2023; 11:1137428. [PMID: 37533522 PMCID: PMC10393129 DOI: 10.3389/fpubh.2023.1137428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/23/2023] [Indexed: 08/04/2023] Open
Abstract
Indigenous people suffer earlier death and more frequent and severe disease than their settler counterparts, a remarkably persistent reality over time, across settler colonized geographies, and despite their ongoing resistance to elimination. Although these health inequities are well-known, they have been impervious to comprehensive and convincing explication, let alone remediation. Settler colonial studies, a fast-growing multidisciplinary and interdisciplinary field, is a promising candidate to rectify this impasse. Settler colonialism's relationship to health inequity is at once obvious and incompletely described, a paradox arising from epistemic coloniality and perceived analytic challenges that we address here in three parts. First, in considering settler colonialism an enduring structure rather than a past event, and by wedding this fundamental insight to the ascendant structural paradigm for understanding health inequities, a picture emerges in which this system of power serves as a foundational and ongoing configuration determining social and political mechanisms that impose on human health. Second, because modern racialization has served to solidify and maintain the hierarchies of colonial relations, settler colonialism adds explanatory power to racism's health impacts and potential amelioration by historicizing this process for differentially racialized groups. Finally, advances in structural racism methodologies and the work of a few visionary scholars have already begun to elucidate the possibilities for a body of literature linking settler colonialism and health, illuminating future research opportunities and pathways toward the decolonization required for health equity.
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Affiliation(s)
- Bram Wispelwey
- Department of Global Health and Population, School of Public Health, Harvard University, Boston, MA, United States
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
| | - Osama Tanous
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
| | - Yara Asi
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- School of Global Health Management and Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, FL, United States
| | - Weeam Hammoudeh
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - David Mills
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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Kahn CB, James D, George S, Johnson T, Kahn-John M, Teufel-Shone NI, Begay C, Tutt M, Bauer MC. Diné (Navajo) Traditional Knowledge Holders' Perspective of COVID-19. Int J Environ Res Public Health 2023; 20:3728. [PMID: 36834423 PMCID: PMC9964790 DOI: 10.3390/ijerph20043728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
From the start of the COVID-19 pandemic on the Navajo Nation, Diné (Navajo) traditional knowledge holders (TKHs), such as medicine men and women and traditional practitioners, contributed their services and healing practices. Although TKHs are not always fully acknowledged in the western health care system, they have an established role to protect and promote the health of Diné people. To date, their roles in mitigating the COVID-19 pandemic have not been fully explored. The purpose of this research was to understand the social and cultural contexts of the COVID-19 pandemic and vaccines based on the roles and perspectives of Diné TKHs. A multi-investigator consensus analysis was conducted by six American Indian researchers using interviews with TKHs collected between December 2021-January 2022. The Hózhó Resilience Model was used as a framework to analyze the data using four parent themes: COVID-19, harmony and relationships, spirituality, and respect for self and discipline. These parent themes were further organized into promoters and/or barriers for 12 sub-themes that emerged from the data, such as traditional knowledge, Diné identity, and vaccine. Overall, the analysis showed key factors that could be applied in pandemic planning and public health mitigation efforts based on the cultural perspective of TKHs.
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Affiliation(s)
- Carmella B. Kahn
- College of Population Health, University of New Mexico, Albuquerque, NM 87131, USA
| | - DeeDee James
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | | | | | | | | | - Chassity Begay
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Marissa Tutt
- Center for Health Equity and Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Mark C. Bauer
- Public Health Program, Diné College, Shiprock, NM 87420, USA
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Cowger TL, Murray EJ, Clarke J, Bassett MT, Ojikutu BO, Sánchez SM, Linos N, Hall KT. Lifting Universal Masking in Schools - Covid-19 Incidence among Students and Staff. N Engl J Med 2022; 387:1935-1946. [PMID: 36351262 PMCID: PMC9743802 DOI: 10.1056/nejmoa2211029] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts - the Boston and neighboring Chelsea districts - sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools. METHODS We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021-2022 school year. Characteristics of the school districts were also compared. RESULTS Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities. CONCLUSIONS Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.
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Affiliation(s)
- Tori L Cowger
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Eleanor J Murray
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Jaylen Clarke
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Mary T Bassett
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Bisola O Ojikutu
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Sarimer M Sánchez
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Natalia Linos
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Kathryn T Hall
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
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